Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | |||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 517,463,814 | 396,476,442 | 471,049,566 | 547,127,976 | 852,169,752 | 2,784,287,550 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 517,463,814 | 396,476,442 | 471,049,566 | 547,127,976 | 852,169,752 | 2,784,287,550 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | 0 | 0 | 0 | 0 | 0 |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support. (Subtract line 7c from line 6.) | 2,784,287,550 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 517,463,814 | 396,476,442 | 471,049,566 | 547,127,976 | 852,169,752 | 2,784,287,550 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,802,889 | 2,671,828 | 3,938,531 | 4,089,372 | 2,685,044 | 15,187,664 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 1,802,889 | 2,671,828 | 3,938,531 | 4,089,372 | 2,685,044 | 15,187,664 |
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | 0 | 0 | 0 | 0 | 0 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 519,266,703 | 399,148,270 | 474,988,097 | 551,217,348 | 854,854,796 | 2,799,475,214 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 21014044 |
| Software Version: | 2021v4.2 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a Part III - Program Service Description | PRIORITY HEALTH CHOICE, INC. RECEIVED A RATING OF 4 OUT OF 5 FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA). THE RATING WAS BASED ON CLINICAL QUALITY, MEMBER SATISFACTION AND NCQA ACCREDITATION SURVEY RESULTS WHICH WERE CONDUCTED ON MORE THAN 1,000 HEALTH INSURANCE PLANS. IN ADDITION TO THIS RECOGNITION FROM NCQA, THE 2021 MEDICAID HEALTH PLAN CONSUMER GUIDE HAS AWARDED PRIORITY HEALTH CHOICE, INC. WITH AN ABOVE AVERAGE OVERALL RATING. THE OVERALL RATING INCLUDES ALL 5 CATEGORIES IN ADDITION TO HOW THE MEMBERS FEEL ABOUT THEIR PLAN AND THE HELP THE MEMBERS RECEIVE FROM THEIR PLAN. CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) IS A SPECIALTY PROGRAM OFFERED BY THE STATE OF MICHIGAN TO PROVIDE CARE FOR CHILDREN AND SOME ADULTS WITH CHRONIC HEALTH CONDITIONS. IN ADDITION, THE CSHCS PROGRAM OFFERS SUPPORT TO THE FAMILIES AND CAREGIVERS OF THE MEMBER. CSHCS PROGRAM ELIGIBILITY IS BASED ON MORE THAN 2,700 MEDICAL DIAGNOSES. AS OF OCTOBER 1, 2012, THE MAJORITY OF THE CSHCS POPULATION TRANSITIONED INTO A MEDICAID HEALTH PLAN. IN RESPONSE TO THIS TRANSITION, PRIORITY HEALTH CHOICE, INC. IMPLEMENTED A SPECIALTY CARE MANAGEMENT PROGRAM FOR THIS UNIQUE POPULATION. A DEDICATED CARE MANAGEMENT TEAM ENSURES CSHCS MEMBERS ARE ESTABLISHED WITH A PRIMARY CARE MEDICAL HOME WHILE ALSO PROVIDING CARE COORDINATION BETWEEN THEIR PRIMARY CARE / SPECIALTY CARE PROVIDERS AND ANY ANCILLARY PROVIDERS. THIS TEAM INCLUDES CARE MANAGERS, COMMUNITY HEALTH WORKERS, FIELD SERVICE REPRESENTATIVES, AND OTHER KEY PARTNERS, INCLUDING COUNTY HEALTH DEPARTMENTS, EARLY ON, EARLY HEAD START, THE INTERMEDIATE SCHOOL DISTRICTS, SPECIALTY PROVIDERS, AND MEDICAL SUPPLIERS. THE CARE MANAGEMENT TEAM ALSO FACILITATES ACCESS FOR FAMILIES TO THE FAMILY CENTER FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, AND THE CHILDREN'S SPECIAL NEEDS FUNDS IN LANSING. AS OF DECEMBER 31, 2021, PRIORITY HEALTH CHOICE, INC. HAS MORE THAN 3,900 MEMBERS ENROLLED IN THE CSHCS PROGRAM, UP FROM APPROXIMATELY 3,300 MEMBERS IN THE PRIOR YEAR. ON SEPTEMBER 16, 2013, THE MICHIGAN GOVERNOR SIGNED INTO LAW MICHIGAN PUBLIC ACT 107 OF 2013, WHICH DIRECTED THE CREATION OF THE HEALTHY MICHIGAN PLAN. THE HEALTHY MICHIGAN PLAN RECEIVED APPROVAL FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES ON DECEMBER 30, 2013. THE STATE OF MICHIGAN BEGAN TO MAKE HEALTH CARE BENEFITS AVAILABLE THROUGH THE HEALTHY MICHIGAN PLAN EFFECTIVE APRIL 1, 2014. THE HEALTHY MICHIGAN PLAN ENCOURAGES HEALTHY BEHAVIORS AND PERSONAL RESPONSIBILITY, HELPS LOW-INCOME MICHIGAN RESIDENTS ACCESS AFFORDABLE HEALTH COVERAGE, AND REDUCES UNCOMPENSATED CARE THAT SHIFTS COSTS ONTO BUSINESSES AND TAXPAYERS. AS OF DECEMBER 31, 2021, PRIORITY HEALTH CHOICE, INC. HAD MORE THAN 78,000 MEMBERS ENROLLED IN THE HEALTHY MICHIGAN PLAN. PRIORITY HEALTH CHOICE, INC. MAKES OUTREACH CALLS TO EACH HEALTHY MICHIGAN MEMBER. DURING THE CALL, MEMBERS ARE PROVIDED WITH BENEFIT EDUCATION AS WELL AS ASSISTANCE IN MAKING THEIR INITIAL PRIMARY CARE PROVIDER ("PCP") APPOINTMENT. DURING THAT INITIAL PCP APPOINTMENT, THE MEMBER COMPLETES A HEALTH RISK ASSESSMENT, WHICH IDENTIFIES CURRENT BEHAVIORS, A MEMBER'S READINESS TO CHANGE, KEY HEALTH METRICS, AND THE PCP ATTESTATION. IN PURSUIT OF THE GOAL THAT 81% OF CONTINUOUSLY ENROLLED MEDICAID MEMBERS WILL HAVE AT LEAST ONE LEAD SCREENING TEST BY THEIR SECOND BIRTHDAY, PRIORITY HEALTH REDESIGNED THE MEDICAID LEAD SCREENING PROGRAM . AS SUCH, PRIORITY HEALTH DEVELOPED A PROGRESSIVE THREE-TOUCH MEMBER OUTREACH REMINDER/INCENTIVE, PURCHASED LAB EQUIPMENT ON BEHALF OF PROVIDER OFFICES AND PROVIDED EDUCATION TO BOTH MEMBERS AND PROVIDERS AROUND THE IMPORTANCE OF LEAD SCREENING. BASED ON 2021 DATA, THE PRIORITY HEALTH CARE EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) RATE FOR LEAD SCREENING WAS 56%. THIS RATE DECLINED DUE TO COVID-19 IMPACTING THE AVAILABILITY OF SERVICES AND THE FREQUENCY IN WHICH MEMBERS WENT IN FOR SERVICES. THE COMMUNITY HEALTH CARE ACCESS PROGRAM (CHAP), FORMERLY KNOWN AS CHILDREN'S HEALTH CARE ACCESS PROGRAM, IS A COMMUNITY COLLABORATIVE THAT WAS INITIATED IN 2008 AND HAS SINCE EXPANDED TO SERVICE ADULT ENROLLEES. THE FOCUS OF THE COLLABORATIVE FOR THE FIRST SEVERAL YEARS WAS TO INCREASE ACCESS AND QUALITY HEALTH CARE TO MEDICAID PEDIATRIC MEMBERS. THE PRIMARY GOAL OF THE CHAP PROGRAM NOW IS TO IMPROVE HEALTH OUTCOMES AMONG CHILDREN ON MEDICAID WHILE BETTER UTILIZING EXISTING RESOURCES AND DECREASING COSTS. THIS PARTNERSHIP BETWEEN PRIORITY HEALTH CHOICE, INC., HELEN DEVOS CHILDREN'S HOSPITAL, CHERRY STREET HEALTH SERVICES, PRIVATE PEDIATRIC PRACTICES, NUMEROUS HUMAN SERVICE AGENCIES, AND PRIVATE FOUNDATIONS COVERS MORE THAN 12,000 CHILDREN IN KENT COUNTY. CHAP CONTRACTED WITH PCP'S, PROVIDING CARE COORDINATION AND ASSISTANCE WITH KEY HEDIS METRICS. PCP'S WERE REIMBURSED AT A HIGHER RATE IN EXCHANGE FOR THEIR WILLINGNESS TO OPEN UP ACCESS, ESPECIALLY SAME DAY ACCESS TO MEMBERS. CHAP PROVIDED SAME DAY TRANSPORTATION TO URGENT PCP APPOINTMENTS AS NEEDED. IN ADDITION, CHAP PROVIDED MEMBER/FAMILY EDUCATION REGARDING APPROPRIATE EMERGENCY ROOM AND URGENT CARE UTILIZATION. IN 2014, CHAP DEVELOPED ITS OWN IDENTITY AS HEALTH NET OF WEST MICHIGAN. AT THE SAME TIME, THE FOCUS OF INTERVENTION EXPANDED TO ADULTS AS WELL AS CHILDREN. HEALTH NET PARTNERED WITH ADULT PRIMARY CARE PRACTICES TO WORK WITH ADULT MEMBERS REGARDING EMERGENCY ROOM AND URGENT CARE USE, WHILE ALSO PROVIDING EDUCATION REGARDING SPECIFIC MEMBER INPATIENT UTILIZATION. IN ADDITION, HEALTH NET HAS PARTNERED WITH OB-GYN RESIDENCY CLINICS TO FACILITATE THE MATERNAL INFANT HEALTH PROGRAM (MIHP) ENROLLMENT FOR PREGNANT WOMEN. HEALTH NET REPORTS A 53% RETURN ON INVESTMENT; FOR EVERY $1 INVESTED IN CHAP SERVICES, $1.53 WAS SAVED IN HEALTH COSTS. |
| Form 990, Part III, Line 4a Part III - Program Service Description | PRIORITY HEALTH CHOICE, INC. CONTINUES TO BE RECOGNIZED FOR THEIR DEVELOPMENT OF PROGRAMS THAT HAVE LED TO INCREASED EFFICIENCY AND PATIENT CARE, HELPING LOWER COSTS, AND INCREASE SERVICE TO IT'S MICHIGAN PATIENTS BY THE MICHIGAN ASSOCIATION OF HEALTH PLANS. PRIORITY HEALTH CHOICE, INC. WAS AWARDED A PINNACLE AWARD IN A PRIOR YEAR FOR ITS CENTERINGPREGNANCY PROGRAM. THE GOAL WAS TO CREATE A COLLABORATIVE MODEL OF SUPPORT FOR MEDICAID MEMBERS WHICH RESULTS IN IMPROVED HEALTH OUTCOMES FOR MOTHERS AND THEIR BABIES, ENHANCED HEALTH EXPERIENCES, AND LOWER COSTS. PRIORITY HEALTH PARTNERED WITH SPECTRUM HEALTH IN SUPPORT OF THE CENTERINGPREGNANCY PROGRAM FOR EXPECTANT MEDICAID MEMBERS AND THEIR BABIES. THROUGH THIS PARTICULAR COLLABORATION, FOCUS WAS PLACED ON MEDICAID MOTHERS AND BABIES; HOWEVER, THE MODEL IS SCALABLE TO OTHER PRODUCTS AND PROVIDERS WITHIN THE PRIORITY HEALTH NETWORK. THE COLLABORATIVE TEAM'S EFFORT RESULTED IN A NEW METHOD OF ENHANCED REIMBURSEMENT TIED TO EACH MEMBER AND EACH VISIT. THE PROGRAM IS AN ADDED BENEFIT TO PRIORITY HEALTH MEDICAID MEMBERS, PROVIDES A PRIORITY HEALTH CARE MANAGER AT THE CLINIC SITE WHO WORKS CLOSELY WITH HIGH-RISK PATIENTS AND REINFORCES CENTERING EDUCATION, AND SUPPORTS AND ENCOURAGES PARTICIPATION IN THE MATERNAL INFANT HEALTH PROGRAM. IN A PRIOR YEAR, THE MAHP AWARDED PRIORITY HEALTH CHOICE, INC. WITH A PINNACLE AWARD RECOGNIZING THE INNOVATIVE MEDNOW APPROACH. PRIORITY HEALTH CHOICE, INC. PARTNERED WITH MEDNOW TO VIRTUALLY CONNECT MEDICAID RECIPIENTS AND PROVIDERS. MEDNOW PROVIDES MEDICAID RECIPIENTS WITH ACCESS TO A COMPUTER IN-HOME, REAL-TIME ACCESS TO PRIMARY CARE PROVIDERS FOR NON-LIFE-THREATENING CONDITIONS, INCLUDING VIDEO VISITS FOR THOSE WITH A WEBCAM AND A STRONG INTERNET CONNECTION. IT HAS PROVIDED EFFECTIVE HEALTH CARE SERVICES TO BENEFICIARIES AT MEASURABLE COST SAVINGS. VIDEO-ENABLED VIRTUAL VISITS USE DATA ANALYTICS TO MEASURE UTILIZATION AND SATISFACTION. IN 2021, PRIORITY HEALTH CHOICE, INC. HAD 4,323 MEDNOW ENCOUNTERS WITH THE MEDICAID POPULATION. IN 2019, PRIORITY HEALTH'S MEDICAID CARE MANAGEMENT TEAM WAS AWARDED THE PINNACLE AWARD IN THE COMMUNITY OUTREACH CATEGORY FOR THEIR MEDICALLY COMPLEX CHILDREN INFORMATION SHARING EVENTS PROJECT FROM THE MICHIGAN ASSOCIATION OF HEALTH PLANS (MAHP). BY WORKING CLOSELY WITH MEDICALLY COMPLEX CHILDREN (CSHCS - CHILDREN'S SPECIAL HEALTH CARE SERVICES) AND THEIR FAMILIES, THEY WERE ABLE TO QUICKLY IDENTIFY THE NEEDS AND GAPS IN KNOWLEDGE RELATED TO CARE COORDINATION BETWEEN THESE FAMILIES AND THE COMMUNITY PROVIDERS THAT SERVE THEM. IN RESPONSE, PRIORITY HEALTH LAUNCHED QUARTERLY MEDICALLY COMPLEX CHILDREN'S INFORMATION SHARING EVENTS. THOSE EVENTS WERE CREATED TO PROVIDE A VENUE FOR HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS THAT SPECIFICALLY WORK WITH THE CSHCS POPULATION, TO NETWORK, SHARE INFORMATION, ESTABLISH REFERRAL PATHWAYS AND WORK COLLABORATIVELY. IN 2021, PRIORTY HEALTH WAS AWARDED THE PINNACLE AWARD IN THE CHRONIC DISEASE MANAGEMENT - GOVERNMENT PROGRAMS - MEDICAID CATEGORY FOR THEIR MEDICAID ASTHMA ENVIRONMENTAL HOUSING PROGRAM. THE MEDICAID ENVIRONMENTAL HOUSING PROGRAM REDUCED EMERGENCY DEPARTMENT VISITS BY 61.4% AND DECREASED ANNUAL MEDICAL SPENDING BY $675,274. IT HAS ACCOMPLISHED THAT BY PARTNERING WITH COMMUNITY ORGANIZATIONS TO PROVIDE IN-HOME VISITS DEDICATED TO HEALTH EDUCATION AND SOCIAL DETERMINANTS OF HEALTH THAT ARE KNOWN TO TRIGGER ASTHMA. SOME OF THE INITIATIVES INCLUDE HOUSEHOLDS RECEIVING TAILORED ASTHMA EDUCATION, AN ASTHMA MANAGEMENT PLAN, COMMUNITY HEALTH WORKER SUPPORT, AND HOUSING REPAIRS WHERE POSSIBLE. IN 2019, PRIORITY HEALTH LAUNCHED THEIR NEW DUAL ELIGIBLE SPECIAL NEEDS PLAN (D-SNP) NAMED PRIORITYMEDICARE D-SNP WHICH WENT INTO EFFECT ON JANUARY 01, 2020. PRIORITY HEALTH IS THE ONLY HEALTH PLAN TO OFFER A D-SNP THROUGHOUT THE ENTIRE LOWER PENINSULA. THIS PLAN WILL SERVE INDIVIDUALS WHO ARE 21 YEARS OF AGE AND OLDER, WHO ARE ALSO FULL BENEFIT DUAL ELIGIBLE BENEFICIARIES. THE D-SNP IS MEANT FOR INDIVIDUALS WITH HIGH RATES OF MULTIPLE CHRONIC CONDITIONS AND DISABILITIES INCLUDING MEDICAL CONDITIONS, BEHAVIORAL HEALTH DIAGNOSIS, PHYSICAL DISABILITIES, INTELLECTUAL OR DEVELOPMENTAL DISABILITIES, AS WELL AS FUNCTIONAL AND/OR COGNITIVE LIMITATIONS. THIS PARTICULAR POPULATION FACES MANY SOCIAL RISK FACTORS THAT CONTRIBUTE TO POOR HEALTH AND OTHER OUTCOMES SUCH AS HOUSING INSTABILITY AND HOMELESSNESS, FOOD INSECURITY, ISOLATION, INADEQUATE OR NO ACCESS TO TRANSPORTATION, AND DISPARITIES IN OTHER SOCIAL DETERMINANTS TO HEALTH. AS OF DECEMBER 31, 2021, PRIORITY HEALTH CHOICE, INC. HAD MORE THAN 6,600 MEMBERS ENROLLED IN THE DUAL ELIGIBLE SPECIAL NEEDS PLAN. |
| Form 990, Part IV, Line 12a Audited Financial Statements | The organization's financial statements are audited annually by an independent accounting firm. The "No" response to this question relates to the fact that the GAAP basis financial statements were prepared on a consolidated basis and not on a stand alone basis. The organization is audited annually on a stand alone basis and issued financial statements on a stand alone basis which are prepared in accordance with SAP (Statutory Accounting Principles), as required by regulatory authorities. The figures in this Form 990 reconcile to the financial statements prepared under statutory accounting principles as submitted to the State of Michigan and the National Association of Insurance Commissioners (NAIC). |
| Form 990, Part V, Line 2a NUMBER OF EMPLOYEES REPORTED ON FORM W-3 | ALL EMPLOYEES OF PRIORITY HEALTH CHOICE, INC. WERE EMPLOYED DURING THE YEAR BY BHSH SYSTEM (38-3382353) AND LEASED BACK TO PRIORITY HEALTH CHOICE, INC. SALARIES AND WAGES, EMPLOYEE BENEFITS AND PAYROLL TAXES ARE ALLOCATED TO PRIORITY HEALTH CHOICE, INC. VIA A MANAGEMENT FEE. THE SALARIES AND WAGES REPORTED IN PART IX STATEMENT OF FUNCTIONAL EXPENSES REFLECT THE PORTION OF SALARIES AND WAGES ALLOCATED TO PRIORITY HEALTH CHOICE, INC. BHSH SYSTEM FILED ALL APPLICABLE IRS TAX FILINGS INCLUDING FORMS W-2 AND W-3 ON BEHALF OF PRIORITY HEALTH CHOICE, INC. |
| Form 990, Part VI, Line 3 Management Services | Priority Health Managed Benefits, Inc. (PHMB), an entity related through common ownership, provides contracted management services to Priority Health Choice, Inc. and its affiliates. Priority Health, a 501(c)(4), is the parent company to the organization. Priority Health's governing body retains control of the activities of PHMB as the governing bodies of Priority Health and PHMB are comprised of the same directors and officers. |
| Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL | The BHSH System Board of Directors (through its Compensation Committee) uses the following process for determining compensation of the top management officials, other officers, and key employees at Priority Health Choice, Inc. Labor market data reflecting comparable organizations and jobs (prepared by independent firms) are relied upon in setting compensation levels. Competitive assessment reports are provided to the Compensation Committee in advance of meetings. The competitive assessment report is prepared by a nationally known independent executive compensation firm. For Calendar Year 2021 (1/1/21-12/31/21), the following surveys, prepared by independent firms, were the primary sources referenced to obtain market data for the review: * Aon: 2020 Total Compensation Measurement Survey: Financial Services Survey * BDO: 2020 USA Health Insurance Plans Survey * Integrated Healthcare Strategies: 2020 National Healthcare Leadership Compensation Survey * Mercer: 2020 IHN Healthcare Compensation Survey * Mercer: 2020 IHN Health Plan Compensation Survey * Sullivan Cotter Associates: 2020 Manager and Executive Compensation in Hospitals and Health Systems Survey In addition, three general industry surveys were referenced: * Aon: 2020 Total Compensation Measurement Survey: General Industry * Mercer: 2020 US Executive Remuneration Suite * Willis Towers Watson: 2020 Executive Compensation Survey In addition to the above data sources, the Compensation Committee approved the creation of a custom peer group of high performing integrated health systems to ensure robust data and a relevant comparator universe. The peer group organizations are approved by the Compensation Committee and consists of healthcare systems similar in revenue size, market competitors, high performers, financially stable as indicated by bond rating and that follow a similar strategy (multi-site systems, health plans). Data for the peer group organizations is compiled by the independent executive compensation firm. Compensation adjustments are approved by Compensation Committee members, consistent with the Spectrum Health compensation philosophy described below. Minutes of Committee discussions and decisions are prepared to memorialize Compensation Committee decisions based upon the above data. Cash compensation data relied upon by the Compensation Committee is national and reflects the compensation paid to executives in comparable jobs in comparably sized health care and / or health insurance organizations. Spectrum Health recruits nationally for its executives. Benefits data reflect national health care / health insurance market practices. This process is intended to assist Spectrum Health in qualifying for the rebuttable presumption of reasonableness (Intermediate Sanctions Regulations) and complying with the potential Spectrum Health Excess Benefit Transaction Policy for those individuals in the group who are disqualified persons. The opinion submitted from the third-party independent consulting firm is in accordance with the provisions of Treasury Regulations Section 53.4958-6(c)(2) and is also intended to satisfy the professional advice requirement of Treasury Regulations Section 53.4958-1(d)(4)(iii). |
| Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES | SEE EXPLANATION PROVIDED FOR FORM 990, PART VI, LINE 15A. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | CERTAIN MEMBERS OF THE BOARD OF DIRECTORS AND OFFICERS OF THE ORGANIZATION ALSO SERVE ON THE BOARD OF DIRECTORS AND/OR AS OFFICERS OF RELATED TAXABLE ENTITIES - Business relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The parent organization is Priority Health (EIN 38-2715520), a tax-exempt 501(c)(4) organization. Priority Health controls 100% of the Organization. Priority Health has two shareholders as follows: BHSH System (EIN 38-3382353), Class A Shareholder - 94.44% Munson Healthcare (EIN 38-2640544), Class B Shareholder - 5.56% All Shareholders are tax-exempt Internal Revenue Code Section 501(c)(3) organizations. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Election of Members and Their Rights from Priority Health Choice, Inc. bylaws: Article V Section 2. Number and Class of Directors. The Board of Directors will be comprised of no less than three (3) and no more than nine (9) directors. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | From Priority Health Choice, Inc. bylaws: Section 1. Votes. Each shareholder of record as determined in accordance with Section 2 of this Article will, at every meeting of shareholders, be entitled to one (1) vote in person or by proxy for each share of capital voting stock of the corporation held by the shareholder. A vote may be cast either verbally or in writing. Unless the Articles of Incorporation or Bylaws state otherwise, all matters will be determined by the vote of the holders of a majority of the issued and outstanding stock in the corporation. Section 2. Record Date for Determination of Shareholders. For the purpose of determining shareholders entitled to notice of, and to vote at, a meeting of shareholders, or any adjourned meeting, or to express consent to or dissent from a proposal without a meeting, or for the purpose of any other action, the Board of Directors may fix in advance a date, not more than sixty (60) days nor less than twenty-one (21) days before the date of the meeting or other action, as the record date for the determination of shareholders. Section 3. Proxies. A shareholder entitled to vote at a meeting of shareholders or to express consent or dissent without a meeting may authorize other persons to act for the shareholder by proxy. No proxy will be deemed operative unless and until signed by the shareholder or the shareholder's authorized agent or representative and filed with the corporation. Unless otherwise provided in the proxy, a proxy is valid only for three (3) years from its date. Section 4. Annual Budget and Strategic Plan. The shareholders will approve the annual budget and strategic plan for the corporation. Section 5. Power to Elect President. The shareholders will select the President of the corporation who may be someone who is not a member of the Board of Directors. Section 6. Removal of Officers and Agents. Any officer or agent may be removed by the shareholders whenever, in their judgment, the business interests of the corporation will be served by the removal. Section 7. Delegation of Powers. For any reason they deem sufficient, whether occasioned by absence or otherwise, the shareholders may delegate all or any of the powers and duties of any officer to any other officer or director. Section 8. Power to Require Bonds. The shareholders may require any officer or agent to file with the corporation a satisfactory bond conditioned for faithful performance of the officer's or agent's duties. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The review process for this Form 990 is as follows: 1. Preparation of the return is supervised and reviewed by the organization's Corporate Tax Manager. 2. A second review is performed by an external CPA firm with expertise in tax-exempt return preparation. 3. The return is reviewed by the organization's finance and legal departments (Including the SVP, Finance and SVP, General Counsel) and shared with the members of the finance committee and board of directors. 4. The organization's SVP, Finance reviews comments or questions received from members of the Board of Directors, if any, to address or to incorporate, as appropriate, into the return prior to filing. |
| Form 990, Part VI, Line 12c Conflict of interest policy | BOARD OF DIRECTORS 1. Conflicts of interest must be disclosed to other members of the Board of Directors and Board of Directors members must not vote or use personal influence on any matter in which the director has a conflict of interest. 2. A person having a financial interest in a proposed transaction or arrangement may make a presentation at a meeting of the Board of Directors or committee considering that transaction or arrangement, but after that presentation he or she shall leave the meeting during discussion and voting on that proposed transaction or arrangement. The person having the financial interest shall not be counted in determining whether a quorum is present. 3. The chairperson of the Board of Directors or committee shall, if appropriate, appoint a disinterested person or committee (including outside advisors) to investigate alternatives to the proposed transaction or arrangement, and to advise whether the proposed transaction or arrangement is in the organization's best interest. 4. The Board of Directors or committee shall exercise due diligence to determine whether the organization can, with reasonable efforts, obtain a more advantageous transaction or arrangement that would not give rise to a conflict of interest. 5. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the Board of Directors or committee shall determine by a majority vote of the disinterested directors and members whether the proposed transaction or arrangement is in the organization's best interest and for its own benefit and whether the transaction is fair and reasonable to the organization, and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 6. The minutes of the meetings of the Board of Directors and all of the organization's committees shall set forth: a) The names of the persons who disclosed a financial interest in a proposed transaction or arrangement involving the organization or any of its subsidiaries and the nature of the financial interest; and b) The names of the persons who were present for discussions and votes relating to such transaction or arrangement, including any discussion of alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection with that matter. The votes of individual members need not be recorded unless otherwise directed by the Board of Directors or committee. 7. There is an ongoing requirement that members of the board of directors complete another disclosure questionnaire at any point during his/her tenure on the board of directors when a new potential conflict of interest arises. If a member of the board of directors completes a disclosure questionnaire as a result of a new potential conflict of interest, that disclosure questionnaire is submitted to the legal and compliance departments for review. MANAGEMENT 1. UPON ACCEPTANCE OF AN EMPLOYMENT OFFER, EACH MEMBER OF MANAGEMENT COMPLETES A CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE. A COPY OF THE MEMBER OF MANAGEMENT'S DISCLOSURE QUESTIONNAIRE IS SENT TO THE COMPLIANCE DEPARTMENT. A COPY OF THE MEMBER OF MANAGEMENT'S DISCLOSURE IS REVIEWED BY THE COI TEAM AND ESCALATED TO THE COI COMMITTEE IF NECESSARY. 2. ANNUALLY, EACH MEMBER OF MANAGEMENT COMPLETES AN ANNUAL CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE ELECTRONICALLY. THE DISCLOSURE QUESTIONNAIRE IS REVIEWED BY THE LEGAL AND COMPLIANCE DEPARTMENTS. 3. THERE IS AN ONGOING REQUIREMENT THAT MEMBERS OF MANAGEMENT COMPLETE ANOTHER DISCLOSURE QUESTIONNAIRE AT ANY POINT DURING HIS/HER EMPLOYMENT WHEN A NEW POTENTIAL CONFLICT OF INTEREST ARISES. IF A MEMBER OF MANAGEMENT COMPLETES A DISCLOSURE QUESTIONNAIRE AS A RESULT OF A NEW POTENTIAL CONFLICT OF INTEREST, THAT DISCLOSURE QUESTIONNAIRE IS SUBMITTED TO THE LEGAL AND COMPLIANCE DEPARTMENTS. 4. THE LEGAL AND COMPLIANCE DEPARTMENTS, IN CONSULTATION WITH EXECUTIVE MANAGEMENT, DETERMINE HOW ANY REPORTED CONFLICTS SHOULD BE MANAGED. MANAGEMENT OF A CONFLICT MAY TAKE A VARIETY OF DIFFERENT FORMS FROM IMPLEMENTATION OF A MANAGEMENT PLAN TO REQUIRING THAT THE MEMBER OF MANAGEMENT CEASE THE ACTIVITY CREATING THE CONFLICT OR, IN EXTREME CASES, LEAVE THE ORGANIZATION'S EMPLOYMENT. MANAGEMENT IS DETERMINED ON AN INDIVIDUAL BASIS BASED UPON THE FACTS AND CIRCUMSTANCES SURROUNDING THE DISCLOSURE. THE PURPOSE OF CONFLICT MANAGEMENT IS TO PROVIDE TRANSPARENCY WITHIN THE ORGANIZATION AND TO ENSURE THAT THE ORGANIZATION'S EMPLOYEES ARE ALWAYS ACTING IN THE BEST INTEREST OF THE ORGANIZATION. |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's Articles of Incorporation and Statutory Financial Statements are on file with the State of Michigan and available to the public on the State's website. The organization's bylaws and internal policies are generally not made available to the public. The overall system consolidated financial statements are provided at https://www.spectrumhealth.org/about-us/value-and-transparency. Financial performance is discussed at an annual public meeting held and posted to https://www.spectrumhealth.org/about-us/value-and-transparency. |
| Form 990, Part VII, Section A, Line 2 Individuals Compensated more than $100,000 | THERE ARE NO INDIVIDUALS REPORTED AS ALL ARE EMPLOYED BY THE PARENT ORGANIZATION BHSH SYSTEM. REFER TO THE DISCLOSURE FOR FORM 990, PART V, LINE 2A FOR FURTHER DETAIL. |
| Form 990, Part VII, Section A COMPENSATION OF DIRECTORS | BASED ON EXTERNAL OPINION BY SULLIVAN, COTTER AND ASSOCIATES, INC., PRIORITY HEALTH CHOICE, INC. COMPENSATES BOARD MEMBERS IN A MANNER THAT IS REASONABLE IN RELATION TO MARKET DATA. BOARD OF DIRECTORS COMPENSATION IS REVIEWED ANNUALLY BY INTERNAL STAFF TO CONFIRM COMPENSATION FALLS WITHIN REASONABLE LIMITS. ANY COMPENSATION AMOUNT IS TREATED AS TAXABLE TO THE BOARD MEMBER AND IS REPORTED AND PROVIDED TO THEM ON FORM 1099, AS REQUIRED ACCORDING TO THE REPORTING THRESHOLDS. CERTAIN BOARD MEMBERS ARE EMPLOYED BY A RELATED ORGANIZATION. COMPENSATION REPORTED IN PART VII, SECTION A, COLUMN E IS FOR SERVICES PERFORMED FOR THE RELATED ORGANIZATION, NOT THE FILING ORGANIZATION. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | CHANGE IN NONADMITTED ASSETS - 74172; |
| Form 990, Part XII, Line 2b Audited Financial Statements | The organization's financial statements are audited annually by an independent accounting firm. The organization issued GAAP basis financial statements which are prepared on a consolidated basis and not on a stand alone basis. The organization is audited annually on a stand alone basis and issued financial statements on a stand alone basis which are prepared in accordance with SAP (Statutory Accounting Principles), as required by regulatory authorities. The figures in this Form 990 reconcile to the financial statements prepared under statutory accounting principles as submitted to the State of Michigan and the National Association of Insurance Commissioners (NAIC). |
| Software ID: | 21014044 |
| Software Version: | 2021v4.2 |